Where Culture and Data Meet: Imaging’s Imperative to Change

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Lawrence R. MuroffIn a February 2013 article for JACR: The Journal of the American College of Radiology entitled “Culture Shift: An Imperative for Future Survival,” Lawrence R. Muroff, MD, CEO of Imaging Consultants Inc, outlined how radiology’s culture needs to evolve to meet the changing demands of US health care. “I think the overwhelming majority of radiology groups believe that what has worked for them in the past will continue to work—that if they just stay the course, they’ll be fine,” Muroff says. “Most groups don’t respond to change until something dramatic happens, at which point the pain of maintaining the status quo exceeds the pain of changing.”

In Muroff’s assessment, the imaging community’s problem boils down to culture. “My definition of culture is how a like-minded group of individuals thinks and acts, and there are a lot of aspects of radiology culture that are unique,” he says. “We make our members full and equal shareholders after a short period of time and without demonstrable goals that have to be met. Our buy-ins are much lower than they would be if calculated on a fair market basis. Businesspeople see that and perceive imaging as easy pickings, because the people in charge don’t get it.”

Demonstration of Value

As a result, the radiology community needs to evolve its culture rapidly, Muroff believes, or face eventual commoditization and obsolescence. “How we respond to the challenges we are facing now will determine how radiology is practiced in the future,” he cautions. “One of the biggest challenges we are facing now involves data.”

As new payment and delivery mechanisms come online nationwide, Muroff elaborates, imaging will face the risk of commoditization like never before. Participation in accountable care organizations (ACOs), for instance, will be a financial necessity for many groups; but how can they establish their merit and payment levels? “If a hospital decides to form an ACO and wants to include a radiology group, how is that group going to be a constructive participant?” he says. “How do they know what portion of the bundled dollar they’re entitled to, and how are they going to justify what they ask for?”

Muroff uses the oft-repeated truism of “at the table or on the menu” to illustrate his point. “Everybody thinks it’s very clever to say you have to be at the table or else you’ll be on the menu, and that is true,” he says, “but what do you do when you get to the table? Who’s going to teach you which fork to use with your salad?”

The comparatively unique business model employed by most radiology groups makes this a particularly crucial question, he points out. “When misfortune hits a radiology group, it’s pretty significant—it’s not, oops, we’re making ten-thousand dollars less a year, it’s the hospital sending out solicitations for someone else to come and take over our contract,” he says. “That pressure is only going to intensify as our health care system evolves.”

Bringing the Data

Data will be key to accomplishing the evolution groups need to undergo in the short timeframe required, Muroff says. “Decisions have to be driven by informed leadership, and the only way to be informed is to have the data you need in hand,” he says. “The problem is most groups still lack the mechanisms to get the data. We can generate relatively simplistic data points, but we still have no mechanism to calibrate the non-clinical work members generate—work that can be just as valuable, if not more valuable, than generating RVUs.”

Muroff adds, however, that as yet, no constituency has stepped forward to aggregate and provide the data needed to effectively operate an ACO or other bundled payment construct, meaning that while imaging currently faces threats, it also has an opportunity. “Most of these initiatives are sorely lacking in leadership,” he notes. “If practices start measuring and generating data on their value right away, they’ll be in the position to drive these new organizations.”

In addition, he points out, that data will be critical to the establishment of future health policy initiatives. “We need to provide the data that those thinkers and theorists in health policy need to make intelligent decisions—the information is not just for radiologists, but for those who are determining where radiology will fit in the future of health care delivery,” he says. “It will be a challenge for all of medicine, and my hope is that imaging can get there first, but we’re going to need data to do it.”